O. Babenko, T. Bodunova

Maxim Gorky Donetsk National Medical University

City Clinical Hospital No. 17, Donetsk

Introduction. In the last decade, Ukraine followed all the developed countries with a radical change in the approaches to abortion due to medical abortion (MA). It has become a leading component of the safe abortion concept adopted by WHO. The course of the postabortion period differs somewhat from that after surgical termination of pregnancy.

The main difference is the duration of bleeding (bloody discharge) after MA. Long menstrual bleeding is an expected consequence of MA. As a rule, bloody discharge gradually decreases within about 2 weeks after MA, but in some cases can persist up to 45 days. Nevertheless, many women regard this feature as a negative characteristic of the method and often ask the doctor for prescription drugs that can eliminate the discharge. One of the drugs from the first line of menstrual bleeding drugs in the world is tranexamic acid (TA).

The aim of this study was to investigate the effectiveness of the TA in reduction of the blood loss and improvement of the quality of life in women after MA.

Materials and methods. The research was conducted from January to December 2013 on the basis of the city clinical hospital N 17, in which a model clinic on safe abortion was established in 2010. The clinic was established in January. All women with ongoing vaginal bleeding10 days after MA were randomly divided into 2 groups: basic (45), which was prescribed TA and for the comparison – without this medication (41), which was monitored over time. The examination included a complete blood count, coagulation system observation, estimates of the total blood loss using piktoral charts and quality of life. These indicators were studied twice: on the 10th day after the abortion and on the 1st day of the first menstruation after abortion.

Results. An analysis of the quality of life of the surveyed women revealed the differences between the groups at the end of the observation, whereas initially there were no such records, namely: women who had long periods of bloody discharge, assessed their physical functioning as well as the emotional and mental state (p <0.05).The study showed a significant decrease in the volume and duration of the blood loss, as well as improvement of the quality of life of women taking TA. At the same time, it should be noted that changes in the parameters of the coagulating system of blood have not been registered in women taking TA after the MA.

Conclusions. Women experiencing discomfort in case of prolonged bloody discharge after MA can take TA as a safe and effective means.

References

1. Safe Abortion: Recommendations for Health Systems on the Questions of Polity and Practice. WHO, 2013. 125 p. (Russian)
2. Order of the Ministry of Health of Ukraine dated December 31, 2010 № 1177 “On Approval of the Clinical Protocol” Comprehensive Help During Unwanted Pregnancy.” (Ukrainian)
3. Turemuratova MA, Igisinov NS, Nugmanov GF. Assessment of the Life Quality of Patients in Obstetric and Gynecological Practice. The Young Scientist. 2011;2(4):145-148. (Russian)
4. de Vries CJ, Wieringa-de Waard M, Vervoort CL, Ankum WM, Bindels PJ. Abnormal vaginal bleeding in women of reproductive age: a descriptive study of initial management in general practice. BMC Women’s Health. 2008;8:7. https://doi.org/10.1186/1472-6874-8-7
5. Harper C, Winikoff B, Ellertson C, Coyaji K. Blood loss with mifepristone-misoprostol abortion: Measure from a trial in China, Cuba and India. Int J Gynaecol Obstetrics. 1998;63:39-49. https://doi.org/10.1016/S0020-7292(98)00102-7
6. Heavy menstrual bleeding. Clinical guideline/ National Collaborating Centre for Women’s and Children’s Health. 2007. [Internet]. Available from: http://www.nice.org.uk/nicemedia/live/11002/30401/30401.pdf.
7. Higham JM, O’Brien PM, Shaw RM. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol. 1990;8:734-739. https://doi.org/10.1111/j.1471-0528.1990.tb16249.x
8. Niinimäki M, Pouta A, Bloigu A, Gissler M, Hemminki E, Suhonen S et al. Immediate Complications After Medical Compared With Surgical Termination of Pregnancy Complications. Obs Gyn. 2009;114(4):795-804. https://doi.org/10.1097/AOG.0b013e3181b5ccf9
9. James AH, Kouides PA, Abdul-Kadir R, Dietrich JE, Edlund M, Federici AB et al. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol. 2011;158(2):1-11. https://doi.org/10.1016/j.ejogrb.2011.04.025
10. Lethaby A, Farquhar C, Cooke I. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev. 2000;4:CD000249. https://doi.org/10.1002/14651858.CD000249
11. Lukes AS, Moore KA, Muse KN, Gersten JK, Hecht BR, Edlund M et al. Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial. Obstet Gynecol. 2010;116(4):865-875. https://doi.org/10.1097/AOG.0b013e3181f20177
12. Roy SN, Battacharya S. Benefits and Risks of Pharmacological Agents Used for the Treatment of Menorrhagia. Drug Safety. 2004;27(2):75-90. https://doi.org/10.2165/00002018-200427020-00001
13. Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: pharmacokinetic profiles, effects on the uterus and side effects. Int J Gynaecol Obstetrics. 2007;99(2 Suppl):160-167. https://doi.org/10.1016/j.ijgo.2007.09.004